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NPI Code Detail

MEDICARE: RICHARD W HUETTER DMD INC

MEDICARE: RICHARD W HUETTER DMD INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist16284OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11619090081OTHEROHPERSONAL NPI

General Provider Information

NPI Number : 1548640568
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICHARD W HUETTER DMD INC
Provider Business Mailing Address
First Line : 1401 S MAIN ST
Second Line : SUITE 201
City : NORTH CANTON
State : OH
Zip : 44720-4289
Country : US
Telephone Number : 330-499-7997
Fax Number : 330-499-7680
Provider Business Practice Location Address
First Line : 1401 S MAIN ST
Second Line : SUITE 201
City : NORTH CANTON
State : OH
Zip : 44720-4289
Country : US
Telephone Number : 330-499-7997
Fax Number : 330-499-7680
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : DR. RICHARD WILLIAM HUETTER
Credential : D.M.D.
Telephone Number : 330-499-7997
Provider Enumeration Date : 06/04/2015
Last Update Date : 06/04/2015

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Directions to “RICHARD W HUETTER DMD INC ” Practice Location

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